Cervical Polyps
- Arlene J. Smalls, M.D.
Basic Information
Definition
A cervical polyp is a growth or tumor protruding from the cervix or endocervical canal. Polyps that arise from the endocervical canal are called endocervical polyps. If they arise from the ectocervix, they are called cervical polyps.
| ICD-10CM CODES | |
| N84.1 | Polyp of cervix uteri |
| D26.0 | Polyp uterine cervix, adenomatous |
Epidemiology & Demographics
Cervical polyps are found in approximately 4% of all gynecologic patients. They most commonly present in perimenopausal and multigravida women between the ages of 30 and 50 yr. Endocervical polyps are more common than cervical polyps and are almost always benign (Fig. E1). Malignant degeneration is extremely rare (1%).
Physical Findings & Clinical Presentation
Polyps may be single or multiple and vary in size from being extremely small (a few mm) to large (4 cm). They are soft, smooth, and reddish-purple to cherry-red in color. They bleed easily when touched. Very large polyps can cause some cervical dilation. There may be vaginal discharge and bleeding associated with cervical polyps if the polyp has become infected.
Etiology
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Most unknown
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Inflammatory
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Traumatic
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Pregnancy
Diagnosis
Differential Diagnosis
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Endometrial polyp
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Prolapsed myoma
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Retained products of conception
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Squamous papilloma
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Sarcoma
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Cervical malignancy
Workup
Polyps are most commonly asymptomatic and are usually found at the time of annual gynecologic pelvic examination. Polyps are also found in women who present for evaluation of abnormal uterine bleeding (intermenstrual or postcoital bleeding) and for profuse vaginal discharge. Polyps are generally painless. Unless a patient had a bleeding abnormality that necessitated evaluation by a physician, polyps would go undiagnosed until the next speculum examination or Pap smear was obtained.
Treatment
Nonpharmacologic Therapy
Simple surgical excision can be done in the office. Most commonly, a polyp is excised by grasping it at the stalk with a sponge forceps or similar device and twisting it off. The provider should be prepared for bleeding post removal, which can be controlled with silver nitrate or Monsel’s solution application. Polyps can also be excised by electrocautery or, in the case of very large polyps, in an outpatient surgical suite. Sexual intercourse and tampon use are to be avoided until the patient’s follow-up visit, usually scheduled 7 to 10 days post removal. Douching and tub baths should be discouraged during the immediate recovery period. Although cervical polyps are overwhelmingly benign, they should be sent to pathology for definitive histologic diagnosis.
Acute General Rx
Generally no medication is needed.
Chronic Rx
Patient is followed up in 7 to 10 days for recheck of the surgical excision site and review of pathology results. If the patient complains of active bleeding, she should be seen immediately. The cervix should be examined at the patient’s routine office gynecologic visits.
Disposition
Because these polyps are almost always benign, no further treatment is usually needed. Annual gynecologic examinations should be performed to check for any evidence of regrowth of the polyp.
Referral
To a gynecologist for removal of polyps
Pearls & Considerations
Comments
A Pap smear should be obtained before removing the polyp. If an abnormal Pap smear is obtained, it is possible that the cause was the polyp. If the pathology report on the polyp reveals any histologic or cytologic abnormality, further evaluation with colposcopy, endocervical sampling, or endometrial biopsy may be necessary. If a cervical colposcopic evaluation is needed, this should also be performed.
During pregnancy the cervix is highly vascularized. If the polyps are stable and benign appearing, they should be observed during the pregnancy and removed only if they cause heavy or abnormal bleeding.
Related Content
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Cervical Polyps (Patient Information)
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Cervical Dysplasia (Related Key Topic)